Mississippi doctors “functionally cure” a toddler of HIV

First reported case for an infant cure; research continues to see if it's replicable.

Mississippi doctors are reporting they have "functionally cured" a two-year-old child of HIV, according to findings presented at the Conference on Retroviruses and Opportunistic Infections (CROI) today. "Functionally cured" in this scenario means the child is now without detectable levels of virus and has not demonstrated any signs of the disease after 10 months without antiretroviral therapy. It's the first well-documented case of such results in an infant and only the second person overall documented with a cure. The first occurred in 2012 as Timothy Brown, later known as "the Berlin Patient," was cured through a bone marrow stem transplant.

Research on the case is still on going, and it has not yet been determined whether these results can be replicated in clinical trials with other HIV-exposed children. The National Institute of Allergy and Infectious Diseases (NIAID) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)—both components of the National Institutes of Health—provided funding to support the analysis presented at CROI. The child remains under the medical care of Hannah Gay, M.D., a pediatric HIV specialist at the University of Mississippi Medical Center in Jackson.

When the child came back and showed no signs of HIV, Gay even thought it was a mistake. “My first thought was, ‘oh my goodness. We have been treating an uninfected child,” she told NBC News. "But I checked the records which confirmed she was, in fact, infected.”

The announcement's press release provided a detailed description of the child's background to date:

"In July 2010, the child was born prematurely in Mississippi at 35 weeks, to an HIV-infected mother who had received neither antiretroviral medication nor prenatal care.

Because of the high risk of exposure to HIV, the infant was started at 30 hours of age on liquid antiretroviral treatment consisting of a combination of three anti-HIV drugs: zidovudine, lamivudine, and nevirapine. The newborn’s HIV infection was confirmed through two blood samples obtained on the second day of life and analyzed through highly sensitive polymerase chain reaction (PCR) testing. PCR tests conducted on separate occasions that indicate the presence of HIV in an exposed infant are considered to have confirmed the diagnosis of infection.

The baby was discharged from the hospital at one week of age and placed on liquid antiretroviral therapy consisting of combination zidovudine, lamivudine, and co-formulated lopinavir-ritonavir. This drug combination is a standard regimen for treating HIV-infected infants in the United States.

Additional plasma viral load tests performed on blood from the baby over the first three weeks of life again indicated HIV infection. However, by Day 29, the infant’s viral load had fallen to less than 50 copies of HIV per milliliter of blood (copies/mL).

The baby remained on the prescribed antiretroviral treatment regimen until 18 months of age (January 2012), when treatment was discontinued for reasons that are unclear. However, when the child was again seen by medical professionals in the fall of 2012, blood samples revealed undetectable HIV levels (less than 20 copies/mL) and no HIV-specific antibodies. Using ultrasensitive viral RNA and DNA tests, the researchers found extremely low viral levels.

Today, the child continues to thrive without antiretroviral therapy and has no identifiable levels of HIV in the body using standard assays."

Also note that she is not cured. She has low levels of the virus in her body. While it may lead to better medicine, it may not keep her from dying from it eventually. She is also still contagious I would expect. At the very least she is in an unknown state all the time. At any point she could be full blown HIV+ again. Sad to see people bring children into the world to inherit the screw ups of the mother.

Just an idea, but is it possible that the child is immune to HIV due to genetic mutation? (read the link on "The Berlin Patient" in the article if you're not familiar with this). This might result in the child appearing infected at first, with the disease slowly disappearing.

Just an idea, but is it possible that the child is immune to HIV due to genetic mutation? (read the link on "The Berlin Patient" in the article if you're not familiar with this). This might result in the child appearing infected at first, with the disease slowly disappearing.

The only way I can even imagine of ever curing HIV (as in zero HIV copies anywhere in the body), is with programmable nanobots. Any other treatment would necessarily require some sort of binding to the HIV particle, which gives the target an opportunity to evolve its way around it.

However, using nanobots to literally rip the HIV virus apart can never be evolved around, any more than humans can evolve their way around gunshot wounds. And even if they did evolve some kind of near-indestructible outer shell, it would prevent them from carrying out their function as a virus.

"The mother and baby continued regular clinic visits to the clinic for the next year, but then began to miss appointments, and eventually stopped attending all together."

Mother didn't get her HIV infected baby back to the hospital with her for five months.Got rid of HIV, stuck with all but criminally negligent parents.

I'm not going to pass judgment on the mother, as for all we know she's grossly under aged and mentally unprepared for the responsibilities of child care, but after reading this:

Quote:

born prematurely in Mississippi at 35 weeks, to an HIV-infected mother who had received neither antiretroviral medication nor prenatal care

...you've just really got to evaluate the situation and thank your lucky stars that you weren't born into that. I don't advocate classist rhetoric, but if you can't afford the child to the extent that you just forego any doctor visits despite your kid having HIV, maybe don't have another one. Ever. Consider it a courtesy to the unborn.

I'm unsure why this is being advertised as an HIV "cure." This child still has a very small but detectable level of HIV virus in her body by ultrasensitive PCR according to the CROI presentation. This means she's just become one of the very few people known as "Long term nonprogressors", or "Elite Controllers" People whose bodies have become able to control the virus to a degree where their viral loads are very low or even undetectable. It was always theorized that if you could hit someone hard and very early after infection with antiretrovirals, you could modify their "viral set point." and hopefully slow the progression of disease. Anyway, this is far too early to call this a HIV "cure" based on the info presented in the NIH press release. It's only been a year. If this child goes through for another 5-10 yrs with no treatment and a never detectable viral load, then maybe. Honestly, the massive press bombardment of this news makes it seem that someone is trying too hard to be the "second person to cure HIV" and be a glory hound.

As some background, I'm an infectious disease physician, and we're all still quite leery of "the Berlin patient" and that claim for cure, and it makes much more sense pathophysiologically how that patient eliminated his viremia than how this child might have.

The only way I can even imagine of ever curing HIV (as in zero HIV copies anywhere in the body), is with programmable nanobots. Any other treatment would necessarily require some sort of binding to the HIV particle, which gives the target an opportunity to evolve its way around it.

However, using nanobots to literally rip the HIV virus apart can never be evolved around, any more than humans can evolve their way around gunshot wounds. And even if they did evolve some kind of near-indestructible outer shell, it would prevent them from carrying out their function as a virus.

In order to survive nanobots, the virus might create some substance that jams or inhibits the bots. Or it might mutate in such a way as to make it undetectable for nanobots: the bots must detect it based on *some* kind of receptor or protein or whatever presumably unique to HIV. Similarly, humans may hide behind walls, run away, throw a knife at the gunman, etc. So you can never be sure that nanobots will be a panacea. But I agree that nanobots sound like a great idea to combat viruses! They could operate with surgical precision.

As screwed up as our system is, that's generally not the case with HIV, particularly for patients on HAART. Resistance developers extremely quickly in the setting of noncompliance, so generally once you're on it, physicians, case managers, and pharmaceutical companies will do anything to help patients stay on it, cost be damned. The same is true for tuberculosis for that matter, up to and including having a nurse bring you your medication and watch you take it every day for six months.

Just an idea, but is it possible that the child is immune to HIV due to genetic mutation? (read the link on "The Berlin Patient" in the article if you're not familiar with this). This might result in the child appearing infected at first, with the disease slowly disappearing.

The article implies that the child had HIV prior to the start of the treatment.

The only way I can even imagine of ever curing HIV (as in zero HIV copies anywhere in the body), is with programmable nanobots. Any other treatment would necessarily require some sort of binding to the HIV particle, which gives the target an opportunity to evolve its way around it.

However, using nanobots to literally rip the HIV virus apart can never be evolved around, any more than humans can evolve their way around gunshot wounds. And even if they did evolve some kind of near-indestructible outer shell, it would prevent them from carrying out their function as a virus.

That's pretty much what the immune system already does to viruses. The viruses evolve around it quite handily by hiding better, whether that means changing surface proteins so the attackers don't recognize them, or in the case of HIV hiding inside of host cells for long periods, or a few other sneaky adaptations.

Evolution works by increasing the future genetic contribution of those better at surviving. Unless you're killing every single virus, the ones that are left will be the ones better at not getting killed, and will reproduce a new generation of viruses that are *all* better at not getting killed. Which is not to say nanobots couldn't possibly do it, but the idea is hardly evolution-proof.

I'm unsure why this is being advertised as an HIV "cure." This child still has a very small but detectable level of HIV virus in her body by ultrasensitive PCR according to the CROI presentation.

Could you link to that? Both the article and the linked release by the NIH say the opposite:

Quote:

A two-year-old child born with HIV infection and treated with antiretroviral drugs beginning in the first days of life no longer has detectable levels of virus using conventional testing despite not taking HIV medication for 10 months, according to findings presented today at the Conference on Retroviruses and Opportunistic Infections (CROI) in Atlanta.

This is the first well-documented case of an HIV-infected child who appears to have been functionally cured of HIV infection—that is, without detectable levels of virus and no signs of disease in the absence of antiretroviral therapy.

If I'm reading it right, though, you might have been confused by this para, which describes how they initially confirmed the infection:

Quote:

Because of the high risk of exposure to HIV, the infant was started at 30 hours of age on liquid antiretroviral treatment consisting of a combination of three anti-HIV drugs: zidovudine, lamivudine, and nevirapine. The newborn’s HIV infection was confirmed through two blood samples obtained on the second day of life and analyzed through highly sensitive polymerase chain reaction (PCR) testing. PCR tests conducted on separate occasions that indicate the presence of HIV in an exposed infant are considered to have confirmed the diagnosis of infection.

[Edit] Actually, rereading it I think I see the problem:

Quote:

The baby remained on the prescribed antiretroviral treatment regimen until 18 months of age (January 2012), when treatment was discontinued for reasons that are unclear. However, when the child was again seen by medical professionals in the fall of 2012, blood samples revealed undetectable HIV levels (less than 20 copies/mL) and no HIV-specific antibodies. Using ultrasensitive viral RNA and DNA tests, the researchers found extremely low viral levels.

But the next paragraph states:

Quote:

Today, the child continues to thrive without antiretroviral therapy and has no identifiable levels of HIV in the body using standard assays. The child is under the medical care of Hannah Gay, M.D., a pediatric HIV specialist at the University of Mississippi Medical Center in Jackson. Researchers will continue to follow the case.

What that means for the article accuracy I wouldn't know (I doubt that "ultrasensitive viral RNA and DNA tests" are "standard assays", taking "standard" to mean "usual", but they don't explicitly state that.) But I'd say you're probably right, in that case. This appears to be a case of my mouth leaping before my brain has time to catch up, so carry on.

(Although, just to quickly add, a) I'd argue that everything in the 'early' stages would be too early to call a flat-out cure, and b) this would seem to be confirmation of that theory you talked about - but of course, it doesn't mean it'd work for everyone, or even the general populace. But then, I'm just a guy on the Internet with a large mouth, so I dunno. ^^;)

"The mother and baby continued regular clinic visits to the clinic for the next year, but then began to miss appointments, and eventually stopped attending all together."

Mother didn't get her HIV infected baby back to the hospital with her for five months.Got rid of HIV, stuck with all but criminally negligent parents.

I'm not going to pass judgment on the mother, as for all we know she's grossly under aged and mentally unprepared for the responsibilities of child care, but after reading this:

Quote:

born prematurely in Mississippi at 35 weeks, to an HIV-infected mother who had received neither antiretroviral medication nor prenatal care

...you've just really got to evaluate the situation and thank your lucky stars that you weren't born into that. I don't advocate classist rhetoric, but if you can't afford the child to the extent that you just forego any doctor visits despite your kid having HIV, maybe don't have another one. Ever. Consider it a courtesy to the unborn.

did you ever consider the possibility she was raped and didnt know she had HIV?

...you've just really got to evaluate the situation and thank your lucky stars that you weren't born into that. I don't advocate classist rhetoric, but if you can't afford the child to the extent that you just forego any doctor visits despite your kid having HIV, maybe don't have another one. Ever. Consider it a courtesy to the unborn.

Watch the movie "Precious". It might provide some perspective on how this sort of situation can come about. Warning: it's one of the most depressing movies I've ever watched.

Also note that she is not cured. She has low levels of the virus in her body. [...] Sad to see people bring children into the world to inherit the screw ups of the mother.

What screw up? You don’t know how the mother contracted HIV (or became pregnant) and I really hope you’re not saying that the child should have been aborted.

Well for one, you can greatly reduce the risk of passing HIV on to the child through prenatal care, which this mother never did. Even if she didn't know she was HIV+ until the day of birth, that is no excuse to skip prenatal check ups. And don't give me crap about health care. No hospital will turn away pregnant women who need prenatal care. If your responsible enough to get knocked up, you should be responsible enough to do whatever it takes for the baby.

The only way I can even imagine of ever curing HIV (as in zero HIV copies anywhere in the body), is with programmable nanobots. Any other treatment would necessarily require some sort of binding to the HIV particle, which gives the target an opportunity to evolve its way around it.

However, using nanobots to literally rip the HIV virus apart can never be evolved around, any more than humans can evolve their way around gunshot wounds. And even if they did evolve some kind of near-indestructible outer shell, it would prevent them from carrying out their function as a virus.

That's pretty much what the immune system already does to viruses. The viruses evolve around it quite handily by hiding better, whether that means changing surface proteins so the attackers don't recognize them, or in the case of HIV hiding inside of host cells for long periods, or a few other sneaky adaptations.

Evolution works by increasing the future genetic contribution of those better at surviving. Unless you're killing every single virus, the ones that are left will be the ones better at not getting killed, and will reproduce a new generation of viruses that are *all* better at not getting killed. Which is not to say nanobots couldn't possibly do it, but the idea is hardly evolution-proof.

The difference between nanobots and the immune system is that the immune system essentially learns from scratch every time it encounters a different-looking threat. Assuming we could embed enough processing power into nanobots to run one of the usual machine learning algorithms (not likely in the medium term, of course), or at least be able to control them remotely, we could utilize a database of previous learned models (transfer learning is my the focus of my thesis, in fact), each nanobot could leverage data from all previous encounters with the HIV virus in every human being. Contrast this to the immune system, which can only use a very limited form of "memory", and only from threats its own body has encountered. Eventually, we could learn to recognize HIV particles faster than they could possibly evolve, and in the limit, we would have already seen anything it could possibly evolve into, because there are only a very limited number of changes it can make to its (relatively) short RNA sequence without losing its core functionality.

Then again, if we did have such a capability, the nanobots would be far superior to our own immune system anyway, so it wouldn't really matter if all our t-cells were killed off.

Also note that she is not cured. She has low levels of the virus in her body. [...] Sad to see people bring children into the world to inherit the screw ups of the mother.

What screw up? You don’t know how the mother contracted HIV (or became pregnant) and I really hope you’re not saying that the child should have been aborted.

Well for one, you can greatly reduce the risk of passing HIV on to the child through prenatal care, which this mother never did. Even if she didn't know she was HIV+ until the day of birth, that is no excuse to skip prenatal check ups. And don't give me crap about health care. No hospital will turn away pregnant women who need prenatal care. If your responsible enough to get knocked up, you should be responsible enough to do whatever it takes for the baby.

No they won't turn ten away, but they will call social services and take the child away. And maybe, just maybe they'll actually have a reason. Or not.Being poor seems to be crime enough these days.

pharmaceutical companies will do anything to help patients stay on it, cost be damned. The same is true for tuberculosis for that matter, up to and including having a nurse bring you your medication and watch you take it every day for six months.

Tuberculosis I can see, but do you have actual evidence for the former? That sounds specious considering the cost of these medications.